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The two reasons are that CBS is activated by estradiol and betaine (Bet), which is twice as high in females compared to males because the enzyme PEMT [Figure 1] is activated by a factor of 2.3 in menstruating females

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4700-C A HIGH-PERFORMANCE COMPUTING ANALYSIS OF CHOLESTASIS-ASSOCIATED GENE VARIANTS IN PATIENTS WITH CHOLESTASIS PHENOTYPE OF UNCLEAR ETIOLOGY Jonas Schumacher 1 , Toni Herta 1 , Thomas Berg 2 , Frank Lammert 3 , Lutz Brusch 4 , Susanne Weber 5 , Michael Kuecken 4 , Madlen Matz-Soja 1 , Janett Fischer 1 , Markus Casper 5 , Albrecht Bhlig 1 and Irina Lambert 5 , (1)Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany, (2)University Hospital of Leipzig, (3)Medizinische Hochschule Hannover Mhh, Hannover, Germany, (4)Tu Dresden, (5)Department of Medicine II, Saarland University Medical Center, Saarland University, Homburg, Germany Background: Heterozygous pathogenic mutations or common polymorphisms in genes encoding the hepatocanalicular transporters ATP8B1 , ABCB11 and ABCB4 , or the bile acid ligand farnesoid X receptor ( FXR ) might contribute to liver injury in patients with an otherwise unexplained cholestasis phenotype

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